Separation anxiety disorder: symptoms, causes and treatment

We have all come into the world as vulnerable beings, because it takes up to a year of brain maturation to take our first hesitant steps, or even to communicate our wills through speech.

This is why relationships with figures of affection are fundamental, since from them the foundation of autonomy and safe exploration of the natural environment is built in a moment of extreme lack of protection.

In this sense, it is essential to gradually stimulate the autonomy of the child, so that he can be ready to take up the challenges inherent in this stage of his life and those that will have to come (such as school or relationships. with his peers).

Separation anxiety disorder it involves the onset of deep anxiety during this natural transition process and is arguably one of the most common psychological problems in childhood.

    What is separation anxiety disorder in children?

    Separation anxiety disorder is present in 4% of children and 1.6% of adolescents. It involves a cervical fear of moving away from figures of affection, Which results in embarrassment in situations where they stray on their side. Very often, it is an imaginary distancing, without objective support, with which the child projects his uncertainty or his anguish towards the future.

    In the following, we will describe what its nuclear symptoms are, as well as the reasons why it can occur and the therapeutic approach we currently have.

    1. Emotional discomfort anticipating a separation of emotional figures

    Children with separation anxiety disorder are sensitive to any clues that might suggest moving away from their loving personas (especially their parents). For this reason, they remain very attentive not only to the events which occur in front of them and which they believe are insinuating, but also to those which could occur in the future, anticipating “threats” which, in all probability, do not. will never show up. .

    In this sense, it is important to consider that, in the first years of life, the projection on the future can be conditioned by a magical thought: the children would formulate hypotheses on reality devoid of adult logic, but which would bring credibility. total in the context of their personal experiences and expectations, turning improbable events (kidnapping, abandonment, etc.) into real and tangible risks. Time then becomes an enemy and a source of stress.

    As the day approaches early, children see increased emotional pain and worry. It can also be seen frequently a resurgence of behavioral aspects of the problem. Thus, it is not uncommon for them to express their fears through reproaches and outbursts of bad temper, which pose a conflict for parents and other caring people (family members, teachers, etc.).

      2. Excessive and persistent worry about losing any of the affected models or taking damage.

      Children with generalized anxiety disorder they are concerned about the health and well-being of their bonded characters, Living in fear of an accident or illness. This is why they develop reassurance behaviors, which consist of investigating the status of their parents by asking questions about the likelihood of them dying or suffering harm (which is experienced with surprise by those referred to). .

      This fear is exacerbated in times when some of those affected develop a common or more serious illness. In the latter case, the family’s attempts to hide the situation may precipitate an attitude of suspicion in the child, which would eventually add uncertainty to his experience of anxiety. In the case of minor pathologies, such as colds or other transient processes, an attitude of excessive worry and anxiety about harmless symptoms may be manifested (Fever, cough, etc.).

      3. Fear of an event that could lead to the separation of the figure from the affection

      One of the most common phenomena in the context of this disorder is the emergence of thoughts about imaginary facts that could precipitate a sudden separation from the parents. These include the likelihood of losing or being kidnapped, or that a third party gains privacy in the home and harms family members.

      This fear coexists with normal fears for the age period, Such as those related to monsters or fantastic beings, and even manages to merge with them in some way (developing fear of Santa Claus at the possibility of having evil intentions, for example).

      It is also common for the child to experience conflicts that arise in the family friction scene with intense anxiety. In this way, he can signal discomfort during discussions between the same parents (daily brawls over ordinary matters) or in the event that one of them shows signs of anger or disagreement with his way of acting. . The latter can explode the belief that one deserves to be punished or that one is “bad”, which it can be deeply rooted in self-esteem and cause fear of abandonment.

        4. Persistent refusal to separate from the home

        In children with separation anxiety disorder, the home can be seen as the primary safe space, so when they move away from it they experience it with overwhelming anguish. This fact is exacerbated during moves, when you move to a new school (Or high school) and on arrival of summer vacation. Such fear can motivate a categorical refusal to participate in a school or school trip, especially when it comes to spending the night away from home.

        The fear of walking away it can be maintained in adolescenceAlthough there is some evidence that separation anxiety disorder tends to reduce its prevalence over time. In this case, the emotion that invades the person can slow down the development of dyadic relationships (friendship, camaraderie, etc.) at a time in life when they generally form the first links outside the family framework.

        5. Concern for loneliness

        The worry of being alone is common in this disorder, being a time when the child perceives an increased likelihood of being kidnapped or lost, Two of the most dreaded situations. This is why the distance of affection figures leads to an inhibition of play and other exploratory behaviors of the environment, not recovering until their presence is reestablished.

        This fear is particularly common at bedtime and intensifies when parents decide to move their child’s bedroom to a separate space.

        In this period of transition, the child expresses the desire to be accompanied, or slips in the middle of the night in the bed of a trusted person. Sometimes you can develop a problem sleeping, Expecting the sounds that might arise in the silence of the house as he feeds his fears with his vivid imagination.

        6. Recurring nightmares about separation from loving characters

        Nightmares in which damage is done to either parent are very common in this disorder and one of the reasons they may reject the idea of ​​sleeping on their own. It is more common in young children because there is a period when the fear of parental separation becomes normal and adaptive. In this case, however, the nightmares cause a profound deterioration in the life of the child and his family (excessively interfering with the areas of operation).

        The content of nightmares, which the child is able to evoke when the parents inquire about the subject (which sometimes happens in the middle of the night), generally deals with the divorce or the appearance of an event. dismal (murders, accidents, etc.). In this case, you may wake up restless, between cries and / or sobs.

        If you go back to sleep immediately and can’t remember anything about what happened the next day morning, it could be a night terror (An intensity of parasomnia increases during periods of stress).

        7. Recurring physical complaints during the separation of the characters concerned or when this is foreseen

        Many children somatize the physical discomfort resulting from the separation. The most common symptoms are headache, pain abdominal pain, dizziness, nausea, cramps, palpitations and chest pain; present it alone or in combination. In addition, they show up in the hours before school or other activities (during which a temporary estrangement from people with whom a bond of affection has been forged is planned).

        This eventuality usually worries parents a lot and motivates visits to the pediatrician, the scans finding no organic cause for such a thriving clinic. Likewise, causes constant absenteeism, Which conditions the acquisition of the knowledge provided for in the child’s course and deserves the adoption of extraordinary measures (repetition of lessons for example). When symptoms persist at school, they may be associated with this space, resulting in an explicit refusal to attend school.

        the causes

        The scientific literature on this issue has sought to determine what are the risk factors for this anxiety disorder, after detecting causes in the environment and in parenting styles. The most important refers to the formation of some unsecured adhesion in one of its three subtypes: worried (feeling of not having help when needed), fearful (rejection of parents in the face of attempts to reconcile) and disorganized (experience of abuse or explicit hostility ).

        Abrupt changes in daily life can also contribute to this problem (moving, enrolling in a new school or institute, etc.), as predictable environments are essential for children’s emotional development.

        Stress due to family situations (Divorce, death of a loved one, birth of a new sibling, etc.) and the experience of rejection in school can also be linked to this problem.

        In turn, there is evidence that adults who suffered from this anxiety disorder in their childhood are more likely to suffer from panic attacks (episodes of acute anxiety).

        Finally, an overprotective parenting style can also be linked to this anxiety disorder, as it would deprive the child of exploring their environment safely and considerably reduce their autonomy. This is why loneliness is experienced as unbearable helplessness, As the child thinks that he does not have the tools to manage it without help.

        The search for a balance between freedom and protection is the key to the care of a child, because it depends on him to forge the first tools to build his autonomy.

        What is your treatment?

        There is effective psychological treatment for this mental health problem, which involves both a cognitive and behavioral approach, as well as the articulation of a plan to promote habits that facilitate coexistence in the home. Psychoeducational treatment is necessary first on the problem (with a functional analysis), so that parents understand what are the most specific causes and can stop at its origin.

        it is recommended actively talk to the child about their feelings, Without avoiding or minimizing them. It is also interesting to help him to get involved in activities shared with his group of peers, and to reinforce the progress which is made towards the development of autonomy. It is also essential to deal naturally with the separation situation and to be accessible at times when the child may need closeness or support.

        Bibliographical references:

        • Ehrenreich, JT, Santucci, LC and Weiner, CL (2008). Separation anxiety disorder in young people: phenomenology, assessment and treatment. Behavioral Psychology, 16 (3), 389-412.
        • Silove, D., Manicavasagar, V. and Pini, S. (2016). Can Separation Anxiety Disorder Slip Your Childhood Bond? World Psychiatry, 15 (2), 113-115.

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